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| UCD |
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See Unemployment Compensation Disability Insurance (UCD).
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| UCR Fee |
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See Usual, Customary, And Reasonable (UCR) Fee.
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| UM |
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See Utilization Management (UM).
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| Unallocated Benefit |
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A Benefit providing reimbursement of expenses up to a maximum but without any schedule of Benefits as such.
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| Underwriting |
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The act of reviewing and evaluating prospective insured persons for risk assessment and appropriate Premium
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| Underwriting Impairments |
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Factors that tend to increase an individual's risk above that which is normal for his or her age.
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| Underwriting Manual |
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A document that provides background information about various Underwriting Impairments and suggests the appropriate action to take if such impairments exist.
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| Underwriting Requirements |
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Requirements, sometimes relating to group characteristics or financing measures, that MCOs at times impose in order to provide healthcare Coverage to a given group and which are designed to balance a Health Plan's knowledge of a proposed group with the ability of the group to voluntarily select against the plan (antiselection).
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| Unemployment Compensation Disability Insurance (UCD) |
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Health Insurance (HI) that covers off-the-job accidents and Sickness. It does not cover disability resulting from an Injury or Sickness covered by Workers' Compensation Insurance. See also Disability Benefits Law.
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| Uniform Billing Code of 1992 (UB-92) |
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This code is scheduled to be implemented on October 1, 1993. It's a federal directive which states how a Hospital must provide their patients with bills, itemizing all services included and billed on each invoice.
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| Uniform Premium |
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A Rating system that is used to calculate Premiums for all insureds with no distinctions as to age, sex or occupation.
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| Uniform Provisions |
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A set of provisions regarding the operating conditions of individual Health policies developed in a model law recommended by the National Association of Insurance Commissioners (NAIC)s and required, with minor variations by almost all jurisdictions, and permitted in all jurisdictions.
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| UR |
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See Utilization Review (UR).
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| Urgent Care |
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Treatment or services provided for a Sickness or an Injury that:
1. Develops suddenly and unexpectedly outside of a Health Care Practitioner's normal business hours; and
2. Requires immediate treatment, but is not of sufficient severity to be considered Emergency Treatment.
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| Urgent Care Facility |
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See Medical Facility - Urgent Care Facility.
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| Urgi-Center |
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An Emergency medical service center which is separate from any other Hospital or medical facility.
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| URO |
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See Utilization Review Organization (URO).
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| Usual and Customary (U&C) Charge |
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A term used to refer to the commonly charged or prevailing fees for Health Services within a geographic area. A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. "Usual and Customary (R&C)" essentially means the same thing as "Reasonable and Customary (R &C) Charge".
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| Usual, Customary, and Reasonable (UCR) |
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The dollar amount the insurance companies believe to be a fair price for the medical service/procedure in a specific geographic area. Companies have developed their own UCR, which often do not reflect the doctor's actual bill. If the doctor's chargers are higher than the companies UCR charge, you generally have to pay the balance. Also see Reasonable and Customary.
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| Usual, Customary, And Reasonable (UCR) Fee |
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The amount commonly charged for a particular medical service by physicians within a particular geographic region. UCR Fees are used by traditional Health Insurance (HI) companies as the basis for physician reimbursement.
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| Utilization |
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This refers to how much a covered Group uses a particular Health Plan or program.
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| Utilization and Review Committee |
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A committee composed of medical personnel whose purpose it is to monitor the health care services and supplies provided toMedicare patients.
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| Utilization Management (UM) |
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Managing the use of medical services to ensure that a patient receives necessary, appropriate, high-quality care in a cost-effective manner.
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| Utilization Review (UR) |
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The evaluation of the Medical Necessity, efficiency, and/or appropriateness of healthcare services and treatment plans. Others define it as, a cost control mechanism by which the appropriateness, necessity, and Quality of health care is monitored by both insurers and employers.
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| Utilization Review Committee |
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Committee that reviews Utilization issues brought to it by the Medical Director, often approving or reviewing policy regarding Coverage, reviewing Utilization patterns of Providers, and approving or reviewing the sanctioning process against Providers.
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| Utilization Review Organization (URO) |
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External reviewers who assess the medical appropriateness of suggested courses of treatment for patients, thereby providing the patient and the purchaser increased assurance of the appropriateness, value, and Quality of healthcare services.
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